health reform 101 plus: basics for texas

7/31/2019 Health Reform 101 Plus: Basics for Texas

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HEALTH REFORM 101 PLUS:BASICS for TEXAS

Monday Morning Edition,July 12, 2010

Sponsored by:One Voice Texas

United Way of Greater HoustonGateway to Care

Harris County Healthcare Alliance

Anne Dunkelberg, Assoc. Director, [email protected] Pogue, Senior Policy Analyst, [email protected] for Public Policy Priorities, 900 Lydia Street - Austin, Texas 78702

Phone (512) 320-0222 (X102) www.cppp.org; www.texasvoiceforhealthreform.org

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Health Reforms Big Picture

1. For the first time:a system making comprehensive careavailable to all* Americans, at a cost they can afford.

2. For the first time: health insurance marketplacerequires insurers to compete based on good care andcustomer service, and not by avoiding covering peopleor denying them care they need.

3. Lays foundation for medical practice reforms based on

effective health care, not just rewarding volume; this isESSENTIAL to cost control and long-term deficitreduction.

* Lawfully present in U.S.


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The Timeline

A number of insurance industry reformsbegin this year. Greatest impact is onpeople with high health care costs.

Also starts building the new systemsneeded to support covering large numbersof uninsured.

The big expansion of coverage starts

January 2014.

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Patients Bill of Rights: New Protections for Health InsuranceThe following provisions take effect at policy renewal starting on September 23, 2010:

For ALL policies:

No more lifetime dollar caps

No denial of coverage or waiting periods for kids with pre-existing conditions.

No arbitrary cancellation of health coverage.

Dependents allowed on parents plan until 26th birthday (even if married).

For non-grandfathered (new) policies. Plans in existence as of March 23, 2010are grandfathered and do not have to comply with these provisions:

Restrictions placed on annual limits.

No co-pays or other out-of-pocket expenses for preventive care.

Ensuring Reasonable Rates 2010: Federal and state government begin annual review of health insurance

premium increases. (state-regulated plans) Grants available to states.

2011: Insurers must pay out 80-85 cents of each premium dollar for medicalbenefits -- or else provide rebates to consumers.

First-Year Reforms


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These provisions take effect within the first year:

Pre-existing Condition Insurance Plan (PCIP) - temporary high

risk pool for uninsured individuals with pre-existing conditions

Info/applications at www.healthcare.gov by 7/1/10

Coverage starts on or after 8/1/10

Small employer tax credits available up to 35% of premium cost.

Info at www.irs.gov/newsroom/article/0,,id=223666,00.html

Grants available to states: (1) to set up an Office of HealthInsurance Consumer Assistance (2) to establish health insuranceexchanges

Begins new $11 billion investment in Community Health Centers.

New funding for training primary care docs, nurses, otherprofessionals.

More First-Year Reforms

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2010: Closing the Rx Doughnut Hole: Shrinks Doughnut Hole by $250 in2010 (rebate), 50% discount on brand-name drugs in the remaining gap;closes doughnut hole entirely by 2020

Jan. 2011: New preventive benefits: adds comprehensive annual check-upplus other prevention benefits, with no out-of-pocket costs.

Adds 12 more years to Medicare Trust Fund Solvency: Not by cutting currentMedicare benefits or doctor fees, but slowing growth in Medicare spendingfrom 2010 to 2019.

New Access to Community-Based Services and Supports: Medicare todaydoes not cover community-based services to help seniors remain in theirhomes. A new voluntary insurance program (CLASS) will provide community-

based assistance services and support. Starts in 2012 or 2013; 5 years to qualifyfor benefits.

The Truth behind the Myths:

SGR Medicare Rate Cuts passed by Congress in 1997 have NOTHING to do withhealth reform, but DO need to be Fixed!

Medicare Advantage: 20-25% of Beneficiaries HMOs are getting 14% more $$ than forthe other 75-80% Seniors. MUST be fixed.

More than $1,100 for each beneficiary in Advantage. These overpayments also drive uppremiums for beneficiaries in traditional Medicare by $86 per year for a couple.

Making MedicareStronger


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Build on current system: Grandfathering will allow many current insurance

plans to stay unchanged for years Medicaid expansion: US citizens to 133% FPL ($14,404 individual; $29,327

for 4). (Increase primary care Medicaid fees to MediCARE level in 2013.)

Reform Private Health Insurance: standard minimum benefits, cant chargemore based on health status, limits on premium increases as people age, nodenial of coverage, no excluding pre-existing conditions, no annual or lifetimemaximums.

New Health Insurance Exchanges where private insurers options can becompared and purchased (like Amazon or Travelocity for insurance).

Open to people without job-based coverage and small employers

All members of Congress get coverage thru exchange

Premium assistance up to 400% of FPL ($88,200 for family of 4)

Sliding scale deductibles/co-pays and out-of-pocket caps, to increaseaffordability & reduce medical bankruptcy

Individual mandate to have coverage (with major exemptions)

Some requirements for employers to contribute, with exemption for allemployers with 50 or fewer workers.

In 2014: Health ReformBuilding Blocks

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>$88,400 for a

family of four;>400% of FPL

Job-based coverage, or Full-cost coverage in the exchange

$66,200-$88,400;300-400% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums capped

at 9.5% of income

$44,100-$66,200;200-300% of FPL

Job-based coverage, or Subsidized exchange coverage: premiums capped

at 6.3 9.5% of income

$29,300-$44,100;133-200% of FPL CHIP

Job-based coverage, or Subsidized exchange coverage:

premiums capped at 3% - 6.3%of income


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Texas Uninsured by Income Today6.1 million uninsured in 2008

100-150% FPL

$22,100-

$33,100

$88,200

150-200% FPL

$33,100-

250-300% FPL

$55,100-

$66,200

200-250% FPL

$44,100-

$55,100

300-400% FPL

$66,200-

$88,200

682K

622K

751K

1.06Million

1.611Million

484K

Annual income limits given for a family of four, 2009 federal poverty level U.S. Census, CPS

898K

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Uninsured Texans by AgeGroup, 2008

65+

0-18

19-64Rate: 32% of

19-64 are

Uninsured

Rate: 20% of 0-18

are uninsured

~2/3 are

below

200% FPL57% are

below

200% FPL

Source: U.S. Census


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Which Texans would Gain Coverage IfReform were Fully Implemented Today?

2.5 million (adults and kids) wouldqualify for help with coverage in

the exchange

500,000+ would qualify forexchange coverage at full cost

1 million U.S. citizen adults wouldnewly qualify for Medicaid

500,000 to 700,000 kids qualify forMedicaid or CHIP right now

CBO predicts 1.5 to 1.8 millionwould remain uninsured 1.5M

500K

1M

500K

2.5M

0 0.5 1 1.5 2 2.5 3

2 Texans gain private exchange coverage for each 1 gaining through Medicaid

Of the 6.1 Million Uninsured Texans today

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Who Will Still be Uninsured? CBO projects 92% of under 65; or 95% of < 65 excluding undocumented will be

covered in 2019.

U.S. Citizens

Those with VERY low income, and those who would pay more than 8% of income for mostaffordable exchange coverage will have no penalty (no mandate)

Some of these may remain uninsured, and pay no penalty

Tax penalties are about 1/6 of cost of coverage

Some will be uninsured because they still cant afford their costs, and will pay a penalty; Othersmay choose not to be covered and pay the penalty

Unknown today: what % of low- & moderate-income Texans may stay uninsured?

Undocumented:

no Medicaid/CHIP (not before, not now),

no premium help, and cannot buy at full cost from exchange best estimates say 40% of undocumented in U.S. TODAY have private coverage

Legal Permanent Residents:

Adults are excluded from Texas Medicaid under state law, but

Can purchase from Exchange and qualify for help with premiums


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Reduced Demand for SafetyNet Care: How Much, How Soon?

+ Medicaid expansion and Exchange coverage

+ $11 billion for FQHCs

- Expansions dont start till 2014 and will take several years toramp up.

- ~ 1 million of Texas 6.1 million uninsured = undocumented

- Uncertainty re: adequacy of premium help: how many willremain uninsured? (CBO:

- Inadequate provider base for ALL TEXANS, not just Medicaid:all capacity will be needed, and expanded capacity critical.

Caveats: (mis)perceptions that:

- Safety net funding/programs no longer needed- Or, only needed for Undocumented, pressure to de-fund

- Temptation to dismantle safety net BEFORE reforms havereduced actual need to balance budgets.

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New State Roles State Medicaid eligibility system must grow,

improve performance

Create and Run a Health Insurance Exchange

Greater Role for TDI in Regulation

New Opportunities for Consumer Assistanceand Education

Needed: Aggressive Initiative to ExpandHealth Care Workforce

Challenge: Texas needs real investments inthese systems, but leadership planning cuts


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State Budget EffectsNow

From now until 2014, the only costs to state budget are fromincreasing Health and Human Services Commission andDepartment of Insurance capacity to handle new duties (nocoverage costs)

We probably wont see estimates of expected HHSC and TDI costsfor the next state budget (2012-2013) for a few more months.

Later

Federal government will pay 100% cost of new Medicaid adults from2014-2016; the state starts paying 5% in 2017, topping out at 10%share in 2020.

States expect to also see increased Medicaid and CHIP enrollmentby uninsured kids who are already eligible today once all theexpansions of 2014 begin, so costs for childrens coverage will goup in the existing Medicaid program, too.

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Medicaid expansion for adults: NO state budget costs until 2017 (federal govt.pays). In 2020, Texas gets $9 federal for every $1 state dollar.

Based on other states, more currently-eligibleTexas children will enroll in Medicaid;state must pay standard Medicaid share ~39% for these already-eligible uninsuredTexas welcome mat children, adds another significant cost to the statebudget.

Medicaid will increase primary care fees (Medicare levels) in 2013 and 2014, Fedspay 100%. State concern: Unless Congress continues to fund, additional costs tostate Medicaid budget 2015 or rates get reduced again.

Some providers increased costs of covering their workers will show up passedthrough in Medicaid rates.

HHSC worst-cost preliminary estimate thru 2023 shows 6:1 ratio of federal dollarsto state costs.

Take-Up rates: CBO assumes ~57%; KFF/Urban Institute 75%; HHSC 91-94%!

Medicaid cost share --even if offset 6-to-1 with federal funds--must be fundedin state budget to some degree as soon as 2014, in context of a severestructural deficit in our state tax system and current leadership unfavorableto increasing revenue capacity, no matter how beneficial to the state.

Benefits & Costs of Health

Reform to State


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Texas Comptrollers EstimatesNew report released June 4; based on CBO estimates (divided

across states according to population) for many items.http://www.cpa.state.tx.us/specialrpt/healthFed/

Includes THHSC estimate for Medicaid 2010-2019:

State costs will increase $5.8 B

Federal funds for Texas will grow $76.3 B

Texas will gain $43.5 B in sliding-scale Exchange help to buyprivate coverage.

Small firms will get $1.9B in tax credits for providing coverage

Businesses will pay $9.3 B penalties; Individuals $2.2 Bpenalties

Texas will gain at least $1.3 B in new premium tax revenues

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Illustration: How Adult Expansion Could

Change Texas Medicaid Budget

Fed Share

Expansion

Adults

$3.33 Billion

State Share

Expansion

Adults

$370 million

Fed Share

2008

$10.8 Billion

State Share

2008

$7.0 Billion

State Share

Welcome Mat

Kids: $400

million

Fed Share

Welcome MatKids : $600

million Baseline Now = Projected TexasMedicaid Services Spending, 2008(Texas HHSC)

Note: this does NOT model increasedadmin costs.

If Covered 1.0 millionnew adults; 400Kkids, @ Current costsand demographics

State share of new adultcosts small relative to federal

share (9:1)

State share of welcome matkids costs could be

comparable due to lessfavorable match


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Medicaid in 2012-2013Texas Budget

NO health reform expansion costs, but admin costs at TDI & HHSC

Revenue shortfall numbers make it obvious: without more revenue,there WILL be deep cuts.

In 2003, Provider Rates were the largest category of HHS (Article II) cut.After partial restorations, the total projected reduction in Medicaid andCHIP rates was about $599 million.

Federal law Medicaid and CHIP maintenance of effort requirementsmean provider rates are the largest program area that states can cut.Health reform MOEs: no eligibility cuts for Medicaid adults until Exchangeopens in 2014; no cuts for children in Medicaid and CHIP through 2019.

Optional adult benefits may also be cut

2003 Lawmakers rejected these cuts: community care and nursinghome care; eliminating Rx coverage for aged, disabled, and adult

clients DID eliminate services of LPCs, SWs, psychologists, LMFTs,

podiatrists, and chiropractors; and adult eyeglasses and hearing aids.(Restored in 2005)

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How is Health ReformPaid For?

Health reform reduces the federal deficit:

New Revenue Higher Medicare tax on individuals/couples earning more than

$200K/$250K per year (2013)

Fees on health care industries gaining millions of new customers

Large employer and individual responsibility requirements

Cost Savings Reduces overpayments to Medicare Advantage plans (currently cost 13%

more than regular Medicare)

Reduces the rate of growth in Medicares costs

New revenue $ Cost savings $New costs for

expanded coverage


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In-depth Look:Employer Responsibility

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Employer-sponsored insurance is the foundation for coverage today.Employer responsibility provisions encourage employers to maintainexisting coverage.

Strictly speaking, the law does not require employers tooffer coverage.

But does require larger employers to contribute financiallyif their employees get subsidized coverage in theExchange.

Penalties are a fraction of the cost of coverage. Small employers (50 or fewer full-time workers)

have no obligation to provide coverage, and areexempt from penalties if they choose not to offercoverage and their workers get help in the exchange.

EmployerResponsibility


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Are you are large employer?50+ full-time equivalent workers

Are any of your full-time employees in asubsidized exchange plan?

Do you have more than 30 full-time employees?

Do you provide health insurance?

Pay penalty, lesser of:

$2,000 x (# of full-time OR $3,000 x # of full-timeworkers 30) workers who receive

credits in the exchange

Nopenalty

Pay penalty$2,000 x

(# of full-timeworkers -30)

yes

yes

yes

yes

No

Adapted from Congressional Research Service, Summary of Potential Employer Penalties Under the PPACA

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Are you a large employer?Large employer = 50+ full time equivalentemployees

Full time = 30+ hours/week on average

Example employer = 38 FT; 20 PT working 24 hr/wk each.

How to count employees to determine if you are a large employer

Employee Type How to Count Example Employer

Full-time(30+ hrs/ week)

Count as one employee each = 38

Part-time(


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Are any of your FT employees in

a subsidized exchange plan? In general, employees are NOT eligible for subsidies inthe exchange if they are offered job-based insurance orare eligible for Medicaid

Exceptions, in cases where job-based coverage: Is unaffordable; if employees premium share is > 9.5% of

household income (several questions remain here) and familyincome is < 400% FPL

OR

Has


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In-depth Look:Small Employer Tax Credits

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Only one-in-three small businesses in Texas offers healthinsurance today.

Cost is the primary reason they cannot provide coverage. Health reform provides tax credits to small businesses to

help them afford coverage starting in 2010. Eligibility: Small firms with 25 or fewer full-time equivalent

employees, average annual wages under $50,000, and employercovers 50% of the premium cost.

Phase I, 2010-2013: Max credit of 35% of employers cost forbusinesses, and 25% for nonprofits.

Phase II, 2014 and on: Max credit of 50% of employers cost forcoverage through the Exchange, and 35% credit for nonprofits.Available for two years.

Max credit is available to small employers with 10 or feweremployees and average wages under $25,000, with phase out assize and wages increase.

Tax Credits for SmallBusinesses


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In-depth Look:Addressing Affordability

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Premium Help: Max % of Family Income forPremiums in Exchange

9.5% (< $695/month)$88,000

(400% FPL)$77,000

9.5% (< $610/month)$77,000(350% FPL)

$66,000

8.1-9.5% (< $522/month)$66,000(300% FPL)

$55,000

6.3-8.1% (< $371/month)$55,000

(250% FPL)

$44,000

4.0-6.3% (< $231/month)$44,000

(200% FPL)$33,000

3.0-4.0% (< $110/month)$33,000

(150% FPL)$29,000

2.0-3.0%; ($37 to $73/month)$29,000

(133% FPL)$22,000

(100% FPL)

To:From:Max % Income for Premiums

Income for a Family of Four


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Out-of-Pocket Costs:Share of Health Costs Covered

under Exchange Plans

70%$88,000

(400% FPL)$77,000

$3,987/indiv.$7,973/family

70%$77,000(350% FPL)$66,000

70%$66,000

(300% FPL)$55,000


73%$55,000

(250% FPL)$44,000

85%$44,000

(200% FPL)$33,000


94%$33,000

(150% FPL)$29,000

To:From:

Out of Pocket MAX as% of income (not incl.

premiums)

Avg. Share ofCosts Covered

Income for a Family of Four

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Examples of Family Costs:Premiums, Out-of-pocket help, and Out-of-pocket Caps

Family of 4 Income,with Coveragethrough Exchange,2014 and later

Maximum

YearlyPremiums

Average %of health

costscovered by

plan(Actuarial

Value)

Cap onUncoveredspending

(not includingpremiums)

UpperLimit onTOTALFamily

Spending(% of income)

150% FPL: $33,075 $880 94% $3,967$4,847

(15%)

250% FPL: $55,125 $4,465 73% $5,950$10,415

(19%)

350% FPL: $77,175 $7,332 70% $7,973$15,305

(20%)

450% FPL: $99,225

(No FinancialAssistance)

NoneBuyersChoice;60-90%

$11,900 n/a


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In-depth Look:Individual Responsibility

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Keeping coverage affordable requires spreading risk over largepool that includes healthy people; individual responsibility to getinsurance makes this possible.

Individual mandate: Starting 2014, most U.S. citizens and legalresidents will be required to obtain coverage meeting minimumstandards for themselves and for their dependents.

Who Is Exempt? No penalty for these:

(1) uninsured if lowest-price Exchange plan costs > 8% of family income;

(2) anyone with income below the tax filing threshold ($9,350 indiv./$18,700couple in 2009)

(3) excused for financial hardship (to be defined);

(4) religious objectors;

(5) Native Americans;

(6) undocumented immigrants (also ineligible for Medicaid or premium help);

(7) incarcerated persons; and

(8) those with a gap in coverage of less than 3 months.

IndividualResponsibility


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Penalty concept: create incentive to take responsibility;funds collected also help support safety net thatuninsured will rely on when sick or injured.

How it Works. Unless exempt: federal income tax penalty is based on # uninsured in a family.

but family max is greater of: 3X individual penalty, or 2.5% offamily income, when fully phased in.

penalties phase in from 2014 to 2016: $95/1% in 2014, $325/2%in 2015; $695/2.5% 2016.

from 2016 on $695 for adults and $375 for children under age 18.

maximum of $2,085 per family or 2.5% of income.

Annual inflation updates to penalty amounts after 2016.


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Penalties for the uninsured are afraction of the cost of getting

insurance.

average annual cost of a family group insurance

premium in Texas today about $13,000, so:

the maximum family penalty of $2,085 would beless than one-sixth of the cost of insuring a

family.



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In-depth Look:Medicaid Changes and the

State Budget

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Texas Medicaid:Who it Helps

Children,

2,131,511

Disabled,

359,937

Elderly,

375,375

Poor Parents,

91,838TANF Parent,

35,158

Maternity,

96,036

January 2010, HHSC data.

Total enrolled 1/1/2010: 3.2 million


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Income Caps for Texas Medicaid and CHIP, 2009

0%

50%

100%

150%

200%

250%

Pregnant

Women

Newborns Age 1-5 Age 6-18 TANF

parent of

2, no

income

Working

Parent of

2

SSI (aged

or

disabled)

Long

Term

Care

CHIP

Mandatory Optional

$24,352/yr

$33,874/yr $33,874/yr

185% 185%

133%

$18,310

100%$2,256 $3,696

12.3% 20.2%74%

$7,884

222%

$24,264$36,620

200%

Income Limit as Percentage of Federal Poverty IncomeAnnual Income is for a family of 3,

except Individual Incomes shown for SSI and Long Term Care

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New State Roles; Medicaid/CHIPEligibility and Enrollment Issues

State Medicaid eligibility system Must overcome current problems and prepare to

accommodate growth

Must have smooth interface with Exchange system

Exchange has option to pay state to do incomeeligibility for insurance subsidies

Medicaid MUST offer online, in person, telephone andmail application options in 2014.

No Wrong Door coordination between Exchange andMedicaid required.

New options for community care services in 2014


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Other SignificantMedicaid Changes

Asset limits abolished for all but aged and disabled Medicaid (MEPD inTX), effective 2014

Expansion adults will get a benchmark benefit plan,

New gross income standard (MAGI) with 5% standard deduction,

Medicaid until 26th birthday for all youth who age out of foster care(2014)

CHIP allowed for state employee kids if premium/cost share exceeds 5%of income, based on July 1997 out-of-pocket costs (updated for inflation);i.e., state cannot increase family costs to take advantage.

Cost reduction: states will get higher rebates for Medicaid Rx

New Options:

New medical home benefit for enrollees with 2+ chronic conditions (2 years 90%match)

State Plan optional HCS benefit (not waiver) up to 3X SSI, tied to higher need

Community First Choice option, enhanced match rate (interaction with optionalHCS not clear yet)

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Medicaid DSH

Given Texas relatively large share of both uninsured U.S. citizens andundocumented residents (the latter ineligible for Medicaid, CHIP, or premiumsubsidies), Texas is likely continue to have one of the highest uninsured ratesrelative to other states.

Reduce national Medicaid DSH allotments by $0.4 billion in 2014; $0.6 billion in2015; and $1.8 billion in 2017, $5 billion in 2018; $5.6 billion in 2019; $4 billionin 2020.

Worst case: If cuts are allocated in proportion to a states share of the totalfederal DSH funding, then Texas share would be reduced by $35 million in2014, $52 million in 2015, $156 million in 2016, $434 million in 2017; $487million in 2018; and $348 million in 2019.

Because DSH cuts are targeted to states with the lowest uninsured rates,Texas should expect smaller cuts than this.

DSH revenue today is small relative to hospitals uncompensated care burden;substantial gains in coveragee.g., covering a million adults in Medicaid--would increase patient revenues for most hospitals by a much larger amountthan the current capped DSH pot (~$1.5 billion All Funds).

UPL future is unclear; ongoing issue of gap between Medicaid rates and costs.


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In-depth Look:Covering Kids

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Focus on Children States cant cut eligibility for childrens Medicaid or CHIP betweennow and 2019 (or lose all federal Medicaid funding, about $18 billiona year in Texas)

CHIP continues through 2019, and feds will begin paying about 95%of Texas CHIP costs starting in October 2015.

CHIP block grant $$ must be reauthorized by Congress for periodafter 9/30/2015.

Now: children of state and school employees can get CHIP IF:

premiums and cost-sharing exceed 5% of family income and

if state premium contributions have not declined below 1997 levels(adjusted for inflation).

In 2014, Children below 133% FPL in CHIP (ages 6-19 from 100-133% FPL) will move into Medicaid; kids 1330-200% will be in CHIP.

If a state runs out of FEDERAL CHIP funds 2014 or later, states canenroll kids in Exchange coverage instead, but only in plans the USHHS Secretary has certified provide both benefits & cost-sharingprotections comparable to CHIP.

Many children above CHIP incomes will gain coverage throughexchange; undocumented children are not helped.


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Health Reform ImplementationTimeline

January 2016: first

benefits forcommunity supportsunder CLASS Act

2016: compacts forinterstate insurancesales.

2018: High-costhealth plan excise taxbegins

MAJOR COVERAGE &

REFORMS BEGINCreation of HealthInsurance Exchanges

Medicaid Eligibility up to133 % FPL

Sliding-scale premiumassistance up to 400 %FPL

Out-of-Pocket subsidies (toreduce out-of-pocket costs)

Out-of-Pocket caps for ALLpersons with high medicalexpenses

Ban annual benefit limits inall plans

Individual Mandate

Employer Responsibility

As of September 23

Prohibit lifetime benefit caps

Prohibit pre-existing conditionexclusions for children

More primary care training $$

Ban Co-pays and other Out-of-Pocket expenses forpreventive care andimmunizations, incl. Medicare

No more Rescissions

Dependent coverage to 26th

birthday

In 2010

Start closing Medicare RxDonut Hole; new Medicareprevention benefits

Grants to states to forconsumer assistance

Expand access to

Community Health Centers

Tax credits for small firms

Rate review medical lossratios

Nationwide interim

high-risk poolcoverage forindividuals with pre-existing conditions

Interim reinsurancefor employersproviding early-retireehealth benefits

Later ImplementationImplement in 2014Takes Effect in 2010Effective in 90 days

For detailed timeline, see www.kff.org

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Use of This Presentation

The Center forPublic Policy Priorities encourages you to reproduce and distribute these slides, whichwere developed for use in making public presentations.

If you reproduce these slides, please give appropriate credit to CPPP.

The data presented here may become outdated.

For the most recent information or to sign up forour free E-Mail Updates, visit www.cppp.org.

CPPP

Center for Public Policy Priorities900 Lydia StreetAustin, TX 78702

P 512/320-0222 F 512/320-0227


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In-depth Look:Closing the Medicare Prescription

Drug Doughnut Hole

Standard Medicare Prescription Drug Benefit, 2010

$310 Deductible

$2,830 in Total

Drug Costs($940 out of pocket)

$3,610 Coverage Gap(Doughnut Hole)

SOURCE: Kaiser Family Foundation illustration of standard Medicare drug benefit for 2010 (standard benefit parameterupdate from Centers for Medicare & Medicaid Services April 2009).

Plan pays 75%

Plan pays 15%;Medicare pays 80%

Enrolleepays 100%

Enrolleepays 5%

Enrolleepays 25%

$6,440 in Total

Drug Costs($4,550 out of pocket)


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In-depth Look:Coverage and Citizenship Status

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U.S.-born

citizen

68%

Naturalized

U.S. Citizen

6%

Not a U.S.

Citizen

26%

Uninsured by Citizenship Status, 2007-08 Average

Most Uninsured Texans areU.S. Citizens

(6.1 million Uninsured in 2008)

Source: CPS Annual Social & Econ. Supplementwww.census.gov/hhes/www/hlthins/hlthins.html

4.1million352,000

1.6 million (~40%legal immigrants)

health reform 101 plus: basics for texas

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